We report a case of Posterior Reversible Encephalopathy Syndrome with Spinal Cord Involvement (PRES-SCI) and analyze the radiographic distribution of spinal cord segment involvement in other reported cases.

PRES is characterized by headache, vision changes, seizures, and encephalopathy due to dysautoregulation of cerebral perfusion. Vasogenic edema is present on brain MRI. PRES with SCI has been identified in a small minority of cases.

Case report and literature review spanning 2007-2019 conducted via Pubmed and Google Scholar. Search terms included ‘Posterior Reversible Encephalopathy Syndrome’, ‘Posterior Leukoencephalopathy Syndrome’, and ‘Spinal Cord’. Cases were included if PRES -SCI was confirmed by MRI.

Literature review yielded 25 cases of PRES-SCI. Our case involved a 55 y.o. man who presented with 3 weeks of headache and nausea, 2 days of progressive leg weakness, and an initial blood pressure of 241/193mmHg. MRI showed vasogenic edema in the posterior aspect of both cerebral hemispheres with extension through the brainstem into the cervical cord to the C6 level. Symptoms improved with treatment of the patient’s BP. Including our case, T2 changes on MRI were limited to the cervical cord segment in 14 (54%), cervical + thoracic segments in 7 (27%), thoracic segment alone in 1 (3.8%), and cervical + thoracic + lumbar spine in 4 (15.4%) cases. Patient age ranged from 7 to 55 years old (mean: 22 y.o.). Extension beyond the cervical segment was present in 8/14 pediatric cases (57%), compared to 4/12 adult cases (33%).  Three of the 4 cases with entire cord involvement occurred in the pediatric group.

PRES can be associated with T2 changes in the spinal cord that likely represents extension of vasogenic edema. In nearly half of PRES-SCI cases, involvement can extend beyond the cervical segment. Children may be more prone to more longitudinally extensive involvement than adults.